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Kentucky Medicare Advantage Plan Options – Top Choices in 2022

Are you searching for the best Medicare Advantage plans in Kentucky for 2022? Becoming enrolled in Medicare Part A and Medicare Part B is an exciting time in your life, and it’s also a time when you should take action and look into things like Medicare Advantage. Medicare Advantage plans in Kentucky are designed for people who are eligible for Medicare and who are looking for replacement plans for Medicare.

What is Medicare Advantage in Kentucky?

Known as Part C or “MAPD,” Medicare Advantage in Kentucky is a Medicare plan that contains three parts in one plan: hospital insurance, medical insurance, and a prescription drug plan.

Where Original Medicare is made up of Medicare Part A and Medicare Part B, Medicare Part C or Medicare Advantage is made up of Part A, Part B, and Part D. This plan has is provided by private health insurance companies and has additional coverage and benefits that Original Medicare and other plans do not.

Benefits and coverage options include:

  • Vision and hearing
  • Dental and Over the Counter Prescription Allowance
  • SilverSneakers
  • Meal Delivery
  • Transport to medical appointments

With a Medicare Advantage plan in Kentucky, Medicare beneficiaries will have a network service area to serve them. They will have their own primary care physician, hospital, and any other facilities to choose from in the network.

For those with either a disability or End-stage Renal Disease, enrollment into a Medicare Advantage plan in Kentucky can occur before 65.

What is the Best Medicare Advantage plan in Kentucky in 2022?

Best for network freedom: Medicare Advantage PPO 

PPO plans will have larger networks with no referrals and monthly premiums ranging from $0 to $100.

Best for lowest out-of-pocket: Medicare Advantage HMO 

HMO Plans use a referral network, most companies offer $0 monthly premiums.

Best for low income or health conditions: Medicare Advantage D-SNP

Dual eligible SNP is for those that have both Medicare and Medicaid, a severe or disabling chronic condition, you need nursing home level care, or entering a facility that qualifies for SNP coverage. The D-SNP plan works with an individual’s Medicaid plan and helps with expenses for:

Part B premium
Monthly premiums

What Medicare Advantage plans are available in Kentucky?

Local HMO plans: 25

Local PPO plans: 21

Regional PPO plans: 3

What changings are coming to Medicare Advantage in Kentucky in 2022?

In 2022, changes instituted by The Centers for Medicare and Medicaid Services will take place and affect the following:

  • Part C Program
  • Medicare Prescription Drug Benefit
  • Medicare Cost Plan Program

These changes are part of the Patients Over Paperwork initiative. These changes are to help increase efficiency and improve a beneficiary’s experience.

Enhancements to the Part C and D Programs/Beneficiary Real-Time Benefit Tool (RTBT)

This tool allows you to see if a more affordable version of a drug exists when your doctor suggests therapy and does the following:

– Access to real-time benefits information
– Beneficiaries can see cost-sharing and shop for alternatives for wellness that cost less

Permitting a Second, “Preferred,” Specialty Tier in Medicare Part D

This change will give Part D plans the following:

– A tool for negotiation
– Lower out of pocket costs
– Exchange products and place them on a preferred specialty tier

Medicare Advantage (MA) and Part D Prescription Drug Plans Program Quality Rating System

This rating system will help with the following:

– Measure and code routine updates for star ratings
– Provide technical clarification for scores calculated for Medicare contracts

Establishing Pharmacy Performance Measures Reporting Requirements

By reporting and disclosing pharmacy performance measured from Medicare Part D, CMS will have better knowledge of how to apply measures to the performance. All measures will be reported, which will give transparency to the public.

Implementing Several Opioid Provisions of the SUPPORT Act

The SUPPORT Act will help to expand drug management programs and give Part D the ability to review statistics of opioid utilization with providers.

SUPPORT stands for:

S – Substance
U – Use-Disorder
P – Prevention that
P – Promotes
O – Opioid
R – Recovery and
T – Treatment

Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements

For Supplemental benefits, the term “primarily health-related” will be expanded on and include that cost-sharing reductions will be allowable.

How much does Medicare Advantage cost in Kentucky?

HMO and PPO plans in most states cost $0 per month. It is more common, however, for PPO plans to have a premium.

In the state of Kentucky, a plan will vary from one service area to another.

The average MAPD plan will cost $19 a month, and a Part D drug deductible will cost $98.

When can you enroll in a Kentucky Medicare Advantage plan?

Initial Enrollment Period/IEP

Eligibility for IEP occurs at 65, and you can join Medicare Part A and Part B health plans. Enrollment typically occurs within three months of an individual turning 65.

Open Enrollment Period/Annual Election Period

Open Enrollment Period: October 15th until December 7th

During this time, you can join, drop, or make changes to a plan. Coverage for Part C starts the following year on January 1rst, but only if the plan is completed by December 7th.

Medicare Advantage Open Enrollment Period

January 1rst through March 31rst

During this enrollment period, you can switch or join Original Medicare or a Medicare Supplement plan.

Special Enrollment Periods/Special Circumstances

Special circumstances could include any of the following:

  • Address changes
  • The plan with Medicare changes
  • Loss of current coverage
  • Coverage through an employer (VA/TRICARE/PACE)
  • Eligibility for both Medicare and Medicaid Extra Help
  • Dropping a Medigap/Medicare Supplement plan
  • State Pharmaceutical Assistance Program enrollment
  • Special needs or disability

5-star Special Enrollment Period

December 8th until November 30th

This star rating enrollment can only be used once for your Kentucky Medicare Advantage plan. Plans are rated with satisfaction surveys. Surveys compare plans based on their quality and performance. The 5-star rating is the highest given to a plan.

Special Enrollment Periods/Extra Help

Extra Help is classified as being eligible for Extra Help, Medicare or Medicaid, or State Pharmaceutical Assistance Program.

When can I make changes to my Medicare Advantage plan?

Annual Election Period: October 15th until December 7th

During this time, you can join, drop, or make changes to a plan. Coverage for Part C starts the following year on January 1rst, but only if the plan is completed by December 7th.

Are Medicare Advantage plans in Kentucky “bad”?

Medicare Advantage enrollment has increased by 10% since 2019.

For Kentucky, penetration is 41%, with a growth of 14% as of 2021.

1. Number of lives enrollment in Medicare Advantage in Kentucky: 281,000+

2. Number enrolled by plan, specifically the three plans below:

Local HMO: 63,792

Local PPO: 149,323

Regional PPO: 49,551

3. Percentage of Medicare beneficiaries enrolled in Medicare advantage in Kentucky: 41%

4. Number of lives enrollment in Medicare Advantage nationwide: 24.1 million

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide: 39%

Common Questions on Medicare Advantage in Kentucky

Are there disadvantages to Medicare Advantage?

1. Network Providers Have Limitations
2. Financially Unpredictable
3. Requires Involvement
4. Lacks Long Term Stability

Medicare Advantage plans in Kentucky are with an insurance company, so they have networks you have to stay within for your physicians, health care specialists, wellness facilities, etc.

Costs with a Medicare Advantage plan in Kentucky can be financially unpredictable. They will have lower premiums when compared to a Medicare Supplement plan but over time out of pocket costs add up from coinsurances, copayments, etc.

You will be required to stay involved with this plan. Knowledge of staying in-network and confirming paid bills will be needed.

Requires Involvement: Medicare Advantage plans will require your attention.

A Medicare beneficiary will also notice that a Kentucky Medicare Advantage plan renews every year and will face changes. Medigap Supplement plans are standardized and will not change like a Part C plan.

What are the four types of Medicare Advantage policies available in Kentucky?

The four types of Medicare Advantage plans are HMO, PPO, PFFS, and SNP.

– Health Maintenance Organization (HMO)
– Preferred Provider Organization (PPO)
– Private Fee for Service (PFFS)
– Special Needs Plans (SNP)

Who are the top three Medicare Advantage plan providers?

  • Blue Cross Blue Shield – 15%
  • Humana – 18%
  • United Healthcare – 26%

What are Medicare SNPs?

An SNP is a Special Needs Plan that is a type Medicare Advantage Plan in Kentucky. It is a plan suited for those with a special need such as a disease, syndrome, or specific characteristics. These plans are set up with Medicare coverage for certain healthcare providers, drug formulations, and benefit choices for special needs Medicare beneficiaries.

Do Medicare Advantage plans include prescription drug coverage?

Yes. Most Medicare Advantage plans include a prescription drug plan. These are called MAPD plans because they are combo plans with built-in prescription drug coverage.

Do Medicare Advantage plans cover the SilverSneakers program in KY?

Most all Medicare Advantage plans in Kentucky have the Silver Sneakers program. If going to the gym is important to you, Speak with your insurance agent about these extra benefits being included in your plan.

Related Topics

Kentucky State Links

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In Kentucky, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.